Privacy PoliciesWebsite Disclaimer
All information provided by the Catholic Medical Center (CMC) website is provided for informational purposes only and does not constitute a legal contract between CMC and any person. Information on this website is subject to change without prior notice. Since medical developments occur daily, this site may contain outdated material. Although every reasonable effort is made to present current and accurate information, CMC makes no guarantees of any kind.
Information on the CMC website is not provided as medical advice, does not establish a patient-provider relationship, and is not intended nor should be assumed to guarantee a specific result. CMC makes no claim that the information presented in this site is comprehensive, or that other treatment options may be any more or less effective than those described here.
In no event shall CMC, any subsidiary or affiliate, or employee or representative thereof be responsible or liable, directly or indirectly, for any damage or loss caused or alleged to be caused by or in connection with the use or reliance on such content, goods, or services available on or through any site or resource.
Health related topics found on any page should not be used for diagnostic purposes or be substituted for medical advice. Only a qualified health care provider may dispense medical advice. As with any new or ongoing treatment, always consult your professional health care providers before beginning any treatment. If you do not have a health care provider, you may contact (603) 626-2626 for a listing of providers in your area.
CMC, any subsidiary or affiliate, or employee or representative thereof, assumes no responsibility or liability for any consequence resulting directly or indirectly for any action or inaction you take based on or made in reliance on the information, services or material on or linked to this site. CMC, any subsidiary or affiliate, or employee or representative thereof shall not be accountable in any way for any use, misuse, self-diagnosis, self-treatment, failure to obtain medical information from a qualified physician, any other lack of action, inappropriate action or delay in seeking appropriate medical treatment for any condition, concern, or event.
CMC makes links available to other Internet sites that may have information of general interest. CMC is in no way responsible for the availability, accuracy, or content of those external sites, nor does it endorse them. »Top
All information contained in this website is copyright protected, unless otherwise noted. Information may be reprinted and or downloaded for personal, non-commercial use only, provided the source of the material is identified and includes a statement that the materials are protected by copyright law. Permission to reprint or electronically reproduce any document or graphic in whole or in part for any non-personal or commercial use is prohibited unless prior written consent is obtained from the respective copyright holder. »Top
By using this website, you agree that you understand and accept the terms listed above. If you do not agree to these terms, you may not use this website. Privacy as it applies to the Internet is changing at a rapid pace. We reserve the right to change our privacy practices to remain in compliance with state and federal laws. »Top
Questions or Concerns
- If you have additional questions and or comments, please e-mail firstname.lastname@example.org. »Top
Catholic Medical Center is committed to the principle of fair and ethical business practices, which includes ensuring the utmost security and confidentiality of records and related information for all its patients, employees, and organizational and administrative operations.
Any breach of confidentiality, including, but not limited to, unauthorized discussion or use of or access to information related to a patient, employee, or Catholic Medical Center's operations, represents a failure to meet the professional and ethical standards expected of all employees, and constitutes a violation of this policy. Records and data which are expressly protected under this policy include, but are not limited to: medical records, appointment scheduling, payroll and personnel records, billing information, contracts, demographics, financial records, marketing and fund development strategies, and present or future business plans. Methods of disclosure include, but are not limited to: data transfer or transmission, verbal or written disclosures, news releases, faxes, documents left in full or partial view, including unattended, connected computer workstations.
The Information Systems Group has implemented systems designed to maximize protection and minimize exposure by unauthorized individuals while promoting valid commerce and communication with other institutions and individuals outside the organization. Catholic Medical Center views any violation of this policy seriously and will take appropriate action upon notification of a breach of confidentiality. »Top
NOTICE OF HIPAA PRIVACY PRACTICES
This Notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Understanding Your Health Record/Information
Each time you visit a hospital, physician, or other health care provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as a:
- Basis for planning your care and treatment;
- Means of communication among the many health professionals who contribute to your care;
- Legal document describing the care you received;
- Means by which you or a third-party payer can verify that services billed were actually provided;
- A tool in educating health professionals;
- A source of data for medical research;
- A source of information for public health officials charged with improving the health of the nation;
- A source of data for facility planning and marketing; and,
- A tool with which we can assess and continually work to improve the care we render and the outcomes we achieve.
Understanding What is in Your Record and How Your Health Information is used Helps You to:
- Ensure its accuracy;
- Better understand who, what, when, where, and why others may access your health information; and,
- Make more informed decisions when authorizing disclosure to others.
Your Health Information Rights
Although your health record is the physical property of the healthcare practitioner or facility that compiled it, the information contained within it belongs to you. You have the right to:
- Request a restriction on certain uses and disclosures of your information as provided by federal regulations (45 C.F.R. §164.522);
- Request a restriction on the disclosure of your information to a health plan when you have paid for services out of your pocket in full;
- Obtain a paper copy of this Notice of HIPAA Privacy Practices upon request;
- Inspect and obtain a copy your health record as provided for in federal regulations (45 C.F.R. §164.524);
- Amend your health record by submitting a written request as provided in federal regulations (45 C.F.R. §164.526);
- Obtain an accounting of disclosures of your health information as provided in federal regulations (45 C.F.R. §164.528);
- Request communications of your health information by alternative means or at alternative locations; and,
- Revoke your authorization to use or disclose health information except to the extent that action has already been taken.
Catholic Medical Center is required to:
- Maintain the privacy of your health information;
- Provide you with this Notice as to our legal duties and privacy practices with respect to information we collect and maintain about you;
- Abide by the terms of this Notice;
- Notify you if we are unable to agree to a requested restriction;
- Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations, e.g., Electronic Transmission;
- Obtain your written authorization to use or disclose your health information for reasons other than those listed in this Notice and permitted under law; and
- Notify you if your health information has been breached. Pursuant to federal regulations, breach notification must occur by first class mail within 60 days of the event. A breach occurs when an unauthorized use or disclosure that compromises the privacy or security of your health information poses a significant risk for financial, reputational, or other harm to you.
We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law. Should our privacy practices change, we will post a revised Notice in brochure racks throughout the organization and on our Internet site. We will not use or disclose your health information without your authorization, except as described in this Notice. This Notice first took effect on 4/1/2003, and was revised on 11/21/2006 and 6/1/2012.
For More Information or to Report a Problem
If have questions and would like additional information, you may contact the HIPAA Privacy Officer at (603)663-6651. If you believe your privacy rights have been violated, you can also file a complaint with the Office for Civil Rights at the address below:
Region I, Office for Civil Rights
Department of Health and Human Services
Government Center, JF Kennedy Federal Building, Room 1875
Boston, Massachusetts 02203
Phone: (617) 565-1340
Fax: (617) 565-3809
TDD: (617) 565-1343
Uses and Disclosures of Health Information
We use and disclose health information about you for treatment, payment and health care operations (TPO). We have provided some examples of TPO below.
We will use your health information for treatment.
For example: Information obtained by a nurse, physician, or other member of your health care team will be recorded in your record and used to determine the course of treatment that should work best for you. Your physician will document in your record his or her expectations of the members of your health care team. Members of your health care team will then record the actions they took and their observations. In that way, the physician will know how you are responding to treatment.
We will also provide your physician or a subsequent health care provider with copies of various reports that should assist him or her in treating you once you're discharged from this hospital.
We will use your health information for payment.
For example: A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.
We will use your health information for regular health operations.
For example: Members of the medical staff, the risk or quality improvement manager, or members of the quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the health care and service we provide.
In addition to our use of health information for treatment, payment and health care operations, there are other circumstances in which we may use and disclose your health information without your authorization. We have provided below a list of those circumstances.
Business Associates: There are some services provided in our organization through contacts with business associates. Examples include physician services in the Emergency Department, radiology and certain laboratory tests. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we've asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.
Directory: Unless you notify us that you object, we will use your name, location in the facility, general condition, and religious affiliation for directory purposes. This information may be provided to members of the clergy and, except for religious affiliation, to other people who ask for you by name.
Appointment Reminders: We may use or disclose your health information to provide you with appointment reminders (such as voicemail messages, postcards or letters).
Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and general condition.
Communication with Family: Health professionals, using their best judgment, may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person's involvement in your care or payment related to your care.
Research: We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.
Funeral Directors: We may disclose health information to funeral directors consistent with applicable law to carry out their duties.
Organ Procurement Organizations: Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.
Marketing: We may contact you to provide information about treatment alternatives or other health-related benefits and services that may be of interest to you. We are required to obtain your authorization for other marketing activities and if we will receive direct or indirect payment for your health information.
Fundraising: We may use your name, address, telephone number, date(s) of service, age, and gender to contact you as part of fundraising efforts for CMC. Any funds raised are used to expand and improve the services and programs we provide to the community. If you do not wish to receive fundraising requests in support of CMC, please send a letter to CMC, Office of Philanthropy, 100 McGregor Street, Manchester, NH 03102. In the event that you contact us with this request, all reasonable efforts will be taken to ensure that you do not receive any fundraising communications from us in the future.
Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.
Workers Compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.
Public Health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability. As well as reporting newly diagnosed cases of cancer to the New Hampshire State Cancer Registry for the purposes of identifying clusters of cancer cases and attempting to identify causes of cancer.
Correctional Institution: If you are an inmate at a correctional institution, we may disclose to the institution or their agents health information necessary for your health and to protect the health and safety of other individuals.
Law Enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a patient authorization or court order.
Abuse or Neglect: We may disclose your health information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect or domestic violence or the possible victim of other violent crimes. We may disclose your health information to the extent necessary to avert a serious threat to your health or safety or the health or safety of others.
Federal law allows Catholic Medical Center to disclose your health information to appropriate health oversight agencies, public health authorities or attorneys, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.
Catholic Medical Center is a fully accredited hospital of the Joint Commission on Accreditation of Healthcare Organizations. Request for a public interview can be made by contacting the Joint Commission at http://www.jointcommission.org/. »Top
PATIENT'S RIGHTS AND RESPONSIBILITIES
The patient has a right to:
- Access to care regardless of race, religion, color, national origin, gender, age, disability, marital status, sexual preferences, ability to pay;
- Respect and dignity;
- Privacy and confidentiality of information;
- A safe environment;
- Identity of everyone who provides services;
- Access to assistance in communication;
- Complete and accurate information about his or her diagnosis, treatment, and progress;
- Communication with persons outside Catholic Medical Center by means of visitors, phone or assisted transmission;
- Informed consent for all procedures according to applicable laws and policies;
- Receive information and be educated about pain, pain relief measures, pain prevention and receive state-of-the-art pain management;
- Transfer to another health care facility;
- Pediatric and adolescent patients have the same rights to privacy and access to care as competent adults; minors exercise their consent to treatment through their parents or legal guardian;
- Receive information about the hospital's per diem charges and request itemized charges;
- Be treated by a physician of his or her choice;
- Know the hospital's rules and regulations; and
- Discuss concerns, complaints and access to ethical consultations.
The patient is responsible for:
- Providing information regarding his or her illness;
- Understanding his or her treatment and following instructions;
- Consideration and respect for the rights of others.
Patient's Rights and Responsibilities are further described in the Patient Information booklet provided to each patient. Inquiries regarding this information should be addressed to the Department Director of the area in which care is being provided. Additional questions or concerns should be referred to the Patient Advocacy Program at Catholic Medical Center (603) 663-6438. »Top
The purpose of this policy is to comply with the Deficit Reduction Act of 2005. The policy will assist independent contractors, employees and members of the medical staff to understand the provisions of the federal and state laws which govern the submission of false claims for reimbursement and all the associated implications, as well as to inform our independent contractors, employees and physicians of their right to report alleged violations of federal and state law.
Detailed information regarding both state and federal false claims laws is attached to this policy. It is important that our independent contractors, employees and physicians understand the provisions of these laws, and how to avoid submitting false claims. The government defines (in part) a false claim as knowingly making, using or causing to be made, or used, a false statement or record to get a claim paid or approved. This somewhat legalese statement includes everything from intentionally documenting false items in the medical record, to not coding appropriately or using the wrong revenue code. There are numerous different data elements that are included when submitting a bill, all must be accurate.
However, please be aware that one does not need to “know” a certain act is in violation of the law, but deliberate ignorance or reckless disregard is sufficient for the government to pursue an action under the False Claim Act. Therefore, there is an affirmation obligation on the hospital to know and understand the rules regarding the submission of claims. The government publishes information on reimbursement and the submission of claim in many forms, and we must understand those rules and regulations before submitting a claim for reimbursement.
Violation of the false claims statutes can subject the hospital to fines between $5,500 and $11,000 plus three times the actual damages sustained by the government. The hospital has in place internal and external audits and subscribes to many publications to help us detect and prevent any problems with our claims. These fines can be eliminated if we find our own errors, notify Medicare, and cooperate in correcting the matter. The statutes require us to respond to investigators as they investigate potential wrongdoing (See CMC's Government Investigations Policy).
Independent contractors, employees and members of the medical staff should also be aware that they may notify the government directly if they believe the hospital does not respond appropriately when given notification of a potential violation. The hospital is prohibited from taking any adverse actions whatsoever against the independent contractor, employee or physician should that person notify the government directly. The specifics are delineated in the hospital's Reporting and Non-Retaliation Policy.
EFFECTIVE DATE: January 1, 2007
REFERENCES: Deficit Reduction Act Policy, Olympic Medical Center, Port Angeles, Washington
Federal False Claims Act (or FCA)
With the high stakes involved in FCA lawsuits, hospitals cannot afford to leave billing and coding compliance up to chance. Healthcare billing and coding compliance refers to CMC's ability to operate within the rules, regulations, and policies set by the government, insurance programs and fiscal intermediary (A commercial insurer contracted by the Department of Health and Human Services for the purpose of processing and administering Medicare claims).
Many hospital employees and members of the medical staff are directly involved in the submission of a hospital claim, including admissions, clinical departments, coding and billing, however, it is important that all independent contractors, employees and physicians have a basic understanding of the FCA.
Hospitals that do not comply with certain governmental rules and regulations face harsh penalties that could result in their exclusion from government-sponsored programs, such as Medicaid and Medicare. Hospitals suspected of fraud or abuse must deal with governmental audits and reviews. These investigations can result in costly civil monetary settlements.
What is the False Claims Act or FCA? The government relies mostly on the FCA to prosecute billing fraud. The FCA imposes civil liability on hospitals (and individuals) that make or cause false or fraudulent claims to the government for payment. Anyone who violates the FCA is liable to the U.S. government for a civil penalty between $5,500 and $11,000, plus three times the amount of the damages that the government sustains. In addition, the government can exclude violators from participating in Medicare, Medicaid, and other government programs.
Who is liable under the FCA? The government can use the FCA against both individuals and organizations that commit billing fraud.
The FCA applies to any person who does the following:
- Knowingly presents the government with a false claim for payment or approval
- Knowingly makes a false statement to get a fraudulent claim paid by the government
- Conspires to defraud the government by getting a false or fraudulent claim paid
- Knowingly makes a false record or statement to conceal, avoid, or decrease an obligation to pay the government
- Causes a false claim to be submitted
- A hospital submits a claim for payment to the government.
- The claim is false.
- The submitter knew it was false, or was in reckless disregard or deliberate ignorance of the correct information.
- The government relied on the information, and as a result, there was harm to the government.
- The key element is the fact that the submitter knew it was false (or made no effort to determine the correct information)!
Examples of False Claims...
- billing of items or services that were never rendered by the health care provider
- billing for services that are medically unnecessary
- upcoding (practice of billing for Medicare/Medicaid using a billing code providing a higher payment rate than the billing code intended to be used for the service or item furnished to the patient)
- billing separately for services that should be bundled
- billing separately for outpatient services that were provided within 72 hours (before or after) an inpatient stay
- billing for a discharge in lieu of a transfer
Lesson here... NEVER submit a false claim to the government. If you know of someone who has submitted a false claim, report it immediately to the Corporate Compliance Officer.
What are qui tams? The FCA includes an important provision that allows private citizens to initiate a lawsuit on behalf of the federal government and request the government to join in the suit. In return, that citizen may share a percentage of any recovery or settlement. This type of lawsuit is known as a qui tam and the individual, or relator, is a “whistleblower”, who brings forth evidence of the crime. The purpose of this qui tam provision is to give an incentive for whistleblowers to come forward to help the government discover and prosecute fraudulent claims by awarding them a percentage of the recovery.
In order for the whistle-blower to share in the recovery, the whistle-blower (or relator) must be the “original source” of the information reported to the federal government. Specifically, the whistle-blower must have direct and independent knowledge of the false claims activities and voluntarily provide this information to the government. If the matter disclosed is already the subject of a federal investigation, or if the healthcare provider or supplier has previously disclosed the problem to a federal agency, the whistle-blower may be barred from obtaining a recovery under the FCA.
Whistleblower Protection - Federal Law
The Federal False Claim Act protects employees who are discharged, demoted, suspended, harassed, or in any manner discriminated against by their employer because of their participation or assistance (e.g., testimony, initiation of investigation) in a false claim action.
The Act entities employees to relief to “make them whole”, including restatement with the same seniority status they would have had but for the discrimination, twice the back pay, interest on back pay, and compensation for any special damages sustained as a result of the discrimination including litigation costs and reasonable attorneys' fees.
New Hampshire False Claims Act NH RSA 167:61-a et seq.
New Hampshire also has its own FCA. The following are the general elements of the Act.
No person shall knowingly make, present or cause to be made, any false or fraudulent claim for payment of any good or service, or for the determination of any rights or benefits under Medicaid or other state assistance program.
No person shall knowingly file a false or fraudulent report which is used to determine a rate for payment for goods or services, or include a false or fraudulent statement or representation in connection with any report or filing.
No person can knowingly file claims for payments of goods or services that are not medically necessary in accordance with professionally recognized standards.
No person can destroy or conceal or cause to be destroyed or concealed any book, record, document, data or instrument used as documentation for any goods or services for which payment is sought under Medicaid or other similar state program.
The NH False Claims Act forbids any knowing and willful conduct involving the solicitation, receipt, offer or payment of any kind of compensation or gift in return for referring an individual or for recommending or arranging the purchase, lease, or ordering of an item or service that may be wholly or partially paid for by Medicaid or other similar state program. This prohibition is often referred to as the antikickback statute, and an identical prohibition exists under federal law.
No person can accept any gift, money, donation or other consideration either as a precondition of admitting or expediting the admission of a patient to a hospital, skilled nursing facility, or intermediate care facility in which the cost of such services to the patient is paid for in whole or in part under Medicaid or other similar program.
The statute defines “knowingly” to mean the following:
- intentionally make or cause to be made any false or fraudulent statement, or
- intentionally offer or cause to be offered or presented, in whole or in part, any fraudulent record, document, data or instrument to any state official or law enforcement personnel, in connection with any audit or investigation involving any claim for payment or rate of payment for any good or service under Medicaid or other similar state program.
New Hampshire - The Whistleblowers' Protection Act (RSA 275-E)
Protection is available to employees who report violations of law or refuse to execute illegal directives, participate in investigations, or hearings.
An employer cannot discharge, threaten, or discriminate against any employee who reports such violations or participates in any such investigations:
- IF the employee, in good faith, reports or causes to report an alleged violation
- OR participates in an investigation, hearing, or inquiry conducted by any government entity or any court
- OR the employee refuses to execute a directive that violates any law or rule that violates any law or rule adopted by the State of NH or political subdivision of the United States. »Top